Black History Month

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01/19/2014 02:48 pm ET | Updated Mar 21, 2014

The Beloved Community: Martin Luther King Jr.’s Prescription for a Healthy Society

By Jeff Ritterman, MD

Image courtesy of Vivien Feyer*

 Dr. Martin Luther King popularized the notion of the “Beloved Community.” King envisioned the Beloved Community as a society based on justice, equal opportunity, and love of one’s fellow human beings.

As explained by The King Center, the memorial institution founded by Coretta Scott King to further the goals of Martin Luther King:

Dr. King’s Beloved Community is a global vision in which all people can share in the wealth of the earth. In the Beloved Community, poverty, hunger and homelessness will not be tolerated because international standards of human decency will not allow it. Racism and all forms of discrimination, bigotry and prejudice will be replaced by an all-inclusive spirit of sisterhood and brotherhood.

How is King’s Beloved Community a prescription for a healthy society?

Fundamental to the concept of the Beloved Community is inclusiveness, both economic and social. The notion that all can share in earth’s bounty describes a society in which the social product is shared far more equally than it is in today’s world. The Beloved Community also describes a society in which all are embraced and none discriminated against.

Economic and social justice are the twin pillars supporting the Beloved Community. These twin pillars are also necessary for a healthy society. What would be the health impacts of living in such a society?

Quite a lot is now known about health and social status. When I was in medical school in the 1970s, we believed that it was the CEO at the top of the hierarchy who would be the first to succumb to a heart attack due to the undue stresses of his high position.

Sir Michael Marmot, in the famous Whitehall Studies, showed that actually the exact opposite is true. The lower one is on the social hierarchy, the lower one’s life expectancy, with an incremental improvement each step up. We humans are exquisitely sensitive to our class standing. Our stress hormones reflect this. Those of us lowest on the social pyramid have the highest stress hormone levels. This seems to be how we are wired. The same is true in baboons.

It turns out that social status is the most powerful determinant of health for a wide range of outcomes including life expectancy, as well as illness and death from cardiovascular, pulmonary, psychiatric, and rheumatologic diseases and some cancers. It’s not only where we find ourselves on the social pyramid that matters, it also matters how that pyramid is shaped. In countries with relatively gentler hierarchies and more income equality, health outcomes and social well-being are generally quite good.

In highly unequal countries, like the United States, health outcome and social well-being suffer. We don’t live as long as our peers in more equal countries, nor do our infants or children. We’re fatter, more of our teens get pregnant, we incarcerate more of our citizens, our children score worse on math and science tests, we trust one another less, and we kill one another more often. We even recycle less often. Greater inequality of income leads to a generalized societal dysfunction. We correctly perceive that we are not all in the same boat, and we are more likely to view the world as a Hobbesian struggle for individual survival and advantage.

The King Center addresses one of the key public health challenges of our time by emphasizing a fairer sharing of the social product and an elimination of poverty and homelessness. Since social causes determine how long we will live and whether or not we will get ill, our prevention strategies must advance health-promoting changes in social policy.

The science suggests that policies that lessen income inequality, like raising the minimum wage and increasing taxes on corporations and the wealthiest among us, are likely to lead to significant population health benefits. 

While social class is the primary determinant of health outcome, racism has a detrimental impact over and above that of low social class. For every class category, some racial groupings that suffer discrimination, like African Americans and Latinos, have worse health outcomes than their white counterparts. How does racial discrimination get under the skin to cause premature illness and death?

Let’s focus for a moment on high blood pressure, a common ailment in African Americans. West Africans of similar heredity do not suffer from high levels of hypertension. What’s the explanation for such high levels in African Americans?

Our brains orchestrate an exquisite symphony of neuro-hormonal signals, resulting in the appropriate blood pressure for the level of threat or challenge we face at any given time. When the brain perceives the threat going up, blood pressure goes up too. The world can be a challenging place for a small biped without sharp teeth or claws. It’s good to be prepared for fight or flight should the situation call for either. The world is even more threatening if your racial group is discriminated against.

The appropriate physiologic response to perceived threat is vigilance and preparedness to run or to fight. Given that racism permeates our social environment, the brain of a person suffering racial discrimination sees hypervigilance as a necessity in order to be able to cope with any challenges that may arise. I imagine that tragedies like the murders of Trayvon Martin and Oscar Grant must reinforce the feeling that hypervigilance is necessary.

The hypervigilant state comes with a price. Chronically elevated blood pressure has a weathering affect on the heart and blood vessels. Being ready to run or to fight all of the time takes it’s toll. Heart disease, strokes, kidney failure and premature death are the results. A normal physiologic response (blood pressure rise) to an unhealthy social environment can lead to illness and death. You would think that one focus of intervention would be on improving the social environment and reducing racism. This is not the case.

The physician who treats the hypertensive patient unwittingly performs the social function of normalizing the status quo by ignoring the root cause of the high blood pressure and focusing exclusively on the patient’s response to drug therapy. Knowledge of the social causation has been largely kept from the physician who was taught in medical school that this is “essential hypertension” as opposed to the very rare instances of hypertension caused by endocrine secreting tumors. The terrible irony is that the patient’s brain felt it “essential” to maintain the blood pressure at elevated levels to deal with the chronic stress that is racism.

The medical world’s response to this phenomenon of stress-induced hypertension, in this case due to racism, is to treat each individual patient with multiple medicines. Controlling blood pressure with medications is an enormous challenge. The brain controls blood pressure. When the brain senses that the social environment is threatening, the blood pressure goes up. The doctor prescribes medicines aimed at interrupting the various neuro-hormonal messages that the brain sends to the heart, blood vessels and kidneys to maintain this elevated stress-induced blood pressure.

The doctor typically prescribes a beta-blocker to counteract the effects of the adrenaline system, thereby decreasing the rate and strength of the heart’s contraction, and lowering the blood pressure. The brain, still aware that the social environment is threatening, counters by having the kidneys hold on to more fluid — driving the blood pressure back up.
The doctor responds with a diuretic. The brain, not to be outdone by the doctor, increases the hormone angiotensin, leading to blood vessel constriction and again driving up blood pressure. The doctor has a medication for this too. She prescribes an ACE inhibitor and perhaps nitrates. At this point the patient’s blood pressure may be controlled, as long as the patient can tolerate the expense, the inconvenience and the side effects.

But unless the structures that perpetuate racism are removed, the next generation of African Americans will meet the same fate and they, too, will need to be treated for high blood pressure. This may be good for “fee for service medicine” and for the pharmaceutical industry, but it will never lead to a healthy society.

Dr. King devoted his life to creating the Beloved Community. By doing so he showed us the path to a society that maximizes empathy, compassion and love and also leads to health and well being. We can realize Dr. King’s dream, but to get there America will need to deal successfully with unresolved issues of class and race. Specifically, we need to share the social product more equally and to provide a livable income for all while at the same time removing any and all structures that promote or allow racism or any other form of discrimination. 

In Dr. Kings words:

“The end is reconciliation; the end is redemption; the end is the creation of the Beloved Community. It is this type of spirit and this type of love that can transform opponents into friends. It is this type of understanding goodwill that will transform the deep gloom of the old age into the exuberant gladness of the new age. It is this love which will bring about miracles in the hearts of men.”

Images courtesy of Vivien Feyer, gifts of the Society for the Support of Chemical Weapons Victims, Tehran, Iran

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Jeff Ritterman, MD Vice President of the Board of Directors, San Francisco Bay Area chapter of Physicians for Social Responsibility

Black History Month

What really happened to Malcolm X?

By Zaheer Ali

Updated 2223 GMT (0623 HKT) February 17, 2015

Earl Grant on the moments after Malcolm X's murder 01:06

Story highlights

• Malcolm X was assassinated on February 21, 1965
• Zaheer Ali: Fifty years later, we still have more to learn from Malcolm X's life

Zaheer Ali served as project manager of the Malcolm X Project at Columbia University, and as a lead researcher for Manning Marable's Pulitzer Prize-winning Malcolm X: A Life of Reinvention. He lectures on African American history. The views expressed are his own. Tune into a CNN special report, Witnessed, The Assassination of Malcolm X, tonight at 9p ET.

(CNN)When Malcolm X was assassinated on February 21, 1965, many Americans viewed his killing as simply the result of an ongoing feud between him and the Nation of Islam. He had publicly left the Nation of Islam in March 1964, and as the months wore on the animus between Malcolm's camp and the Nation of Islam grew increasingly caustic, with bitter denunciations coming from both sides. A week before he was killed, Malcolm's home -- owned by the Nation of Islam, which was seeking to evict him -- was firebombed, and Malcolm believed members of the Nation of Islam to be responsible. For investigators and commentators alike, then, his death was an open and shut case: Muslims did it.

Yet although three members of the Nation of Islam were tried and found guilty for the killing, two of them maintained their innocence and decades of research has since cast doubt on the outcome of the case. Tens of thousands of declassified pages documenting government surveillance, infiltration and disruption of black leaders and organizations -- including Malcolm X and the Nation of Islam -- suggest the conclusions drawn by law enforcement were self-serving. Furthermore, irregularities in how investigators and prosecutors handled the case reflect at best gross negligence, and at worst something more sinister.

Photos: Civil rights activist Malcolm X

At the time of his death, Time magazine remembered Malcolm X unsympathetically as "a pimp, a cocaine addict and a thief" and "an unashamed demagogue." But for those who had been paying closer attention to him, Malcolm X was an uncompromising advocate for the urban poor and working-class black America. Instead of advocating integration, he called for self-determination; instead of nonviolence in the face of violent anti-black attacks, he called for self-defense. He reserved moral appeals for other people committed to social justice; the government, on the other hand, he understood in terms of organized power -- to be challenged, disrupted and/or dismantled -- and sought to leverage alliances with newly independent African states to challenge that power.

It was his challenge to the organized power of the state that appealed to growing numbers of African-Americans, and it was this challenge that also attracted a close following among federal, state and local law enforcement. Under Federal Bureau of Investigation Director J. Edgar Hoover's watch, the FBI kept close tabs on Malcolm's every move through the use of informants and agents. Even before Malcolm began attracting large audiences and widespread media coverage in the late 1950s and early '60s, the FBI reported on his efforts to organize Nation of Islam mosques around the country. One organizing meeting in a private home in Boston in 1954 had maybe a dozen or so people present; one of them reported to the FBI.

Ilyasah Shabazz on learning about her father's life 01:24

After Malcolm left the Nation of Islam in March 1964, agents pondered the prospect of a depoliticized more religious Malcolm, but still perceived him as a threat. On June 5, 1964, Hoover sent a telegram to the FBI's New York office that simply and plainly instructed, "Do something about Malcolm X enough of this black violence in NY." One wonders, what that "something" was.

In New York, the FBI's actions were complemented by, if not coordinated with, the New York Police Department's Bureau of Special Services, which regularly logged license plates of cars parked outside mosques, organizational meetings, business and homes. The actions of the police on the day of Malcolm's assassination are particularly noteworthy. Normally up to two dozen police were assigned at Malcolm X's rallies, but on February 21, just a week after his home had been firebombed, not one officer was stationed at the entrance to the Audubon ballroom where the meeting took place. And while two uniformed officers were inside the building, they remained in a smaller room, at a distance from the main event area.

The lack of a police presence was unusual and was compounded by internal compromises on the part of Malcolm's own security staff, which included at least one Bureau of Special Services agent who had infiltrated his organization. Reportedly at Malcolm's request, his security had abandoned the search procedure that had been customary at both Nation of Islam and Muslim Mosque/Organization of Afro-American Unity meetings. Without the search procedure, his armed assassins were able to enter the ballroom undetected. When the assassins stood up to shoot Malcolm, his security guards stationed at the front of the stage moved not to secure him, but to clear out of the way.

These anomalies, in and of themselves, could have been inconsequential. But combined, even if just by coincidence, they proved to be deadly, and allowed for one of the most prophetic revolutionary voices of the 20th century to be silenced. The investigation that followed was just as careless. The crime scene was not secured for extensive forensic analysis -- instead, it was cleaned up to allow for a scheduled dance to take place that afternoon, with bullet holes still in the wall!

For activists, of course, Malcolm X's death took on greater significance than law enforcement publicly expressed. Congress of Racial Equality Chairman James Farmer was among the first to suggest that Malcolm's murder was more than just an act of sectarian violence between two rival black organizations. "I believe this was a political killing," he asserted, in response to Malcolm's growing national profile within the civil rights movement. He called for a federal inquiry -- unbeknownst to Farmer, an ironic request given the level of covert federal oversight that was already in place.

Slowly, Farmer's doubts gained considerable traction. Author and journalist Louis Lomax, who had covered Malcolm X and the Nation of Islam on several occasions, put Malcolm X's assassination in context with Martin Luther King Jr.'s in "To Kill a Black Man" (1968). More than four decades ago, activist George Breitman was among the first to challenge the police version of who was responsible for Malcolm X's death. More recently, the work done at Columbia University's Malcolm X Project, culminating in Manning Marable's Pulitzer Prize-winning "Malcolm X: A Life of Reinvention," echoed these doubts and put at the forefront these unanswered questions about Malcolm X's murder.

These questions deserve answers. They call upon us to revisit not just the political significance of Malcolm X's life, but the implications of his murder. Our government especially deserves scrutiny for its covert information gathering, disinformation campaigns, and even violence waged against its own citizens. Fifty years later, we still have more to learn from Malcolm X's life, and his death, and our government's actions toward him.

The Southern Times

SMALL-AND-medium-sized enterprises (SMEs) are businesses whose personnel numbers fall below certain limits. SMEs play a major role in most economies, particularly in developing countries. 

Feb 21, 2017

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> Dr Moses Amweelo 

However, the working conditions are often very poor and expose employees to a potential wide range of health and safety risks, access to finance is also a key constraint to SMEs’ growth; without it, many SMEs languish and stagnate.
In December 2012, the Bank of Namibia (BoN) granted a licence to SME Bank Namibia Limited, a majority government-owned banking institution that is mandated to provide access to financial services for small and medium Namibian enterprises.
In sub-Saharan African countries with comparable income, small and medium scale enterprises are the most important part of the economy, at least in terms of employment, but often, also in terms of production (Hansohm, Dirk 1996).
Within the small business sector, small formal businesses can be distinguished from informal businesses (Hansohm, Dirk 1996).
These sub-sectors are different in their legal status and more importantly, in the technologies they utilise.
The small formal business sector in Namibia is the smallest in terms of enterprise, number, employment, turnover and value addition.  I
t consists of a few hundred businesses providing employment to a few thousand workers.
The informal sector consists of enterprises with small numbers of employed, self-employed and part-time activities. The main occupations in this sector include:
 carpentry and joinery
 metal fabrication
 motor vehicle repairs, including car battery 
 shoe repairing and cleaning 
 distribution and re-selling of essential commodities such as sugar, cooking oil, and manufacture of simple agricultural implements in order to earn a living.
The only drawback is that the conditions under which this class of workers work are extremely unhygienic and hazardous in some cases. It is a recognized fact that workers in both the formal and informal sectors are exposed to numerous ergonomic problems of varying kinds and degrees.
Ergonomics in often considered for improving work environment in its material aspects, through the design of appropriate work tools, establishing safety procedures or training at the workplace (Sylvain Biquand, Brice Labille IEA 1997).
In large enterprises, organisational and management consequences of changing the way people perform labour are generally buffered by the diverging positions of management and ergonomics.
“Ergonomics in often considered for improving work environment”
In small companies; the ergonomist can directly link management and workers’ activity, with the opportunity to promote an organisational from work rather than the organisation of work.
The application of ergonomics can
result in numerous improvements to reduce the potential for occupational accidents and diseases and in the enhancement of basic working conditions. Ergonomic work-stations can help prevent multiple risks at the workplace, sucks as risks of accidents, musculoskeletal disorders and stress-induced illness.
According to Sylvain Biquand (IEA 1997), improving work conditions together with quality and productivity could only be achieved through participatory design of work environment, based on accurate knowledge of real situations and incidents faced during production.
This is the minimal commitment of an agronomist’s intervention.
However, as a process, continuous improvements of work conditions and productivity should be based on:
● Acknowledging, rather than denying, at all decision levels, that a variety of distinct interests are at work in the enterprise each with its own rational needs. The machine should be maintainable and useably, changing demands of the market should be met, people should work (in their physiological, psychological and sociological diversity), etc. The agronomist should provide facts as well as organisational tools for debating and co-ordinating intrinsically different perspectives.
● Recognizing the organisational value of work activity.
Through interfacing with the variability of concrete situations, work activity is the place of constant reactions and adjustment that should be transformed through appropriate organisational into reactivity and adjustability. Ensuring work activity to remain the motor of change gives a strategic edge to the enterprise through a better touch with reality leading to more liable foresight, and renewed involvement of employees.
Further, ergonomic interventions are generally suited to involving people at the workplace because the interventions directly concern work methods and equipment encountered daily by these people.
An International Labour Organisation (ILO) research has shown that in applying ergonomics in small-scale industries, low-cost solutions have a particular place. Many small-scale producers have shown their capacity to innovate work process, sometimes proving solutions to occupational health and safety problems.
The ILO researchers in 1987compiled and documented 100 examples of “low-cost ways of improving working conditions” in Asia, and similar work are in progress in East Africa.
While this capacity should be tapped, it is not realistic to rely totally on the initiative and capacity of small-scale producers and employers to solve problems in the work environment.
If they do not have the money, skills, mobility or time to resolve hazards associated with the use of equipment, the responsibility shifts to the manufacturers who furnish the sector.
The inputs to small-scales procedures should incorporate, as far as possible, basic safety features in design, low-cost, use of local material, easy maintenance and affordable, widely distributed spare parts. Labelling and safety instructions should be adequate and should be written in local languages.

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